Healthcare Provider Details

I. General information

NPI: 1083527428
Provider Name (Legal Business Name): LEGACY LANTERN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5309 W HUNTINGTON DR
LAVEEN AZ
85339-2434
US

IV. Provider business mailing address

5309 W HUNTINGTON DR
LAVEEN AZ
85339-2434
US

V. Phone/Fax

Practice location:
  • Phone: 602-332-6854
  • Fax:
Mailing address:
  • Phone: 602-332-6854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: ABDULRAHMAN BIHI
Title or Position: OWNER
Credential:
Phone: 602-332-6854